Provider Demographics
NPI:1538053673
Name:CAMPOS, JENISE ANN (LPN)
Entity type:Individual
Prefix:
First Name:JENISE
Middle Name:ANN
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 SAGINAW ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4159
Mailing Address - Country:US
Mailing Address - Phone:503-560-8011
Mailing Address - Fax:
Practice Address - Street 1:2401 RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5412
Practice Address - Country:US
Practice Address - Phone:541-916-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10023538164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse